Abstract
A variety of retrievable and other types of temporarily placed stents are currently being used. However, only a few studies have considered primary endoscopic realignment with temporary urethral stent insertion in the event of traumatic bulbar urethral injury. We aimed to compare the clinical effectiveness and complications between thermo-expandable urethral stents and polymer-coated bulbar urethral stents (BUSs) for the treatment of traumatic bulbar urethral strictures. Between September 2011 and March 2018, 30 patients who had been diagnosed with complete bulbar urethral rupture following blunt trauma underwent temporary urethral stent placement after primary realignment. Thermo-expandable nickel-titanium alloy urethral stents were placed for 15 patients (group M), and retrievable self-expandable polymer-coated BUSs were placed for another 15 patients (group A). All stents were removed within 6 months after placement. The complications and maintained patency rates were compared between the two groups. The mean stent indwelling period was 5.0 ± 2.5 months in group M and 4.9 ± 4.0 months in group A. Both groups maintained high patency rates (Group M 12/15 (80.0%) and group A 13/15 (86.7%)). Five patients who developed urethral stricture underwent direct visual internal urethrotomy (DVIU), and no patients required repeat DVIU or open surgical urethroplasty. Both groups maintained the mean maximal urinary flow rate (Qmax) at 12 months after stent removal. Discomfort (46.7% vs. 6.7%), granulation tissue formation (73.3% vs. 26.7%) and post-void dribbling (80.0% vs. 20.0%) were more frequent in group M than in group A (p = 0.013, p = 0.011 and p = 0.001, respectively). In conclusion, both stents were effective for managing traumatic complete bulbar urethral rupture after primary realignment. However, the thermo-expandable urethral stents had a higher complication rate while the stent was in situ than the BUSs.
Highlights
The bulbar urethra is the most common injury site in the anterior urethra for non-iatrogenic trauma [1,2]
We identified 36 patients who had suffered complete bulbar urethral rupture caused by blunt trauma between September 2011 and March 2018
We investigated the complications of two popular temporary urethral stents and found that bulbar urethral stents (BUSs) have a lower incidence of stent-related complications than the Memokaths; this seems to be primarily related to the structural difference between the two stents
Summary
The bulbar urethra is the most common injury site in the anterior urethra for non-iatrogenic trauma [1,2]. The majority of injuries are caused by blunt trauma, mostly including ‘straddle injuries’, vehicular accidents, or kicks to the perineum [3]. In these bulbar injuries, the urethra may be either partially or completely disrupted, resulting in the loss of urethral continuity, local bleeding, urinary extravasation, inflammation and scarring. Immediate suprapubic cystostomy followed by delayed urethroplasty is preferred if the stricture has been confirmed [7,8]. Long-term suprapubic tube drainage is associated with complications, including wound infection, urinary tract infection, catheter encrustation, urinary leakage, patient discomfort and inconvenience in performing daily activities that can decrease the patient’s quality of life [9]
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